Determine indications, contraindications, and considerations on 3 varying walking tests. Properly selecting between the 10 meter, 2 minute, and 6 minute walk tests when assessing cardiopulmonary conditions.
Objectives:
The objectives of this page are to:
Understand the process of 10 meter, 2 minute, and 6 minute walk tests.
Learn the considerations and contraindication of each test.
Learn when it’s appropriate to use each test.
Differing between tests for proper assessment selection.
Information:
10 Meter Walk Test(3, 4) Purpose: Assesses gait speed over a distance of 10 meters. Can be employed to determine functional mobility, gait and vestibular function. Method: Individual walks without assistance for 10 meters and the time is measured in the middle 6 meters to allow 2 meters for acceleration and 2 meters for deceleration. Start time when toes of leading foot cross the 2 meter mark and stop time when toes of leading foot cross 8 meter mark. Can be performed at preferred walking speed or fastest speed possible. Perform 3 trials and calculate the average of the 3 trials. Instruction form can be found at: http://assets.ngin.com/attachments/document/0052/8705/10_Meter_Walk_Test_Protocol.pdf Population: Used to assess Alzheimer's disease, MS, Parkinson's disease, SCI, Stroke, TBI, Hip fracture, LE amputation, and Geriatrics. Considerations: An assistive device can be used, but should remain consistent and documented from test to test. Can be done at normal gait speed or maximum gait speed, just needs to be documented. Contraindications:
If physical assistance is required to walk
Equipment Needed:
Stopwatch
Clear pathway
Tape to measure set distances
Norms:Vary for each disease and for gait speed performed. Norms vary by age and gender as well.
2 Minute Walk Test (5,6) Purpose: Two minute walk test can be used to measure physical endurance and function in an older patient population with various diagnosis. Method: Measure distance participants walk without assistance in 2 minutes on a hard, flat, indoor surface. A hallway shorter than 100 feet may be used. Participants are instructed to walk at their fastest speed, but are allowed to self-adjust/slow down if needed. Encouragement from administer is used, but exact protocol needs to documented. Instruction form can be found at: http://www.rehabmeasures.org/PDF%20Library/2%20Minute%20Walk%20Test%20Instructions.pdf Population: Most commonly for patients with cardiopulmonary dysfunction. Patients with varying co-morbidities that precludes them from performing more intensive tests. Considerations: An assistive device can be used, but should remain consistent and documented from test to test. This test is most commonly used when patients have co-morbidities that affect their physical or functional endurance, and they are unable to perform a test that lasts longer. Can also be used to assess gait speed and velocity. This test may also be used when space is problem, a hallway that is less than 100 feet long is adequate. Contraindications:
If physical assistance is required to walk
Uncontrolled heart disease
High blood pressure (resting HR > 120, SBP of 180 mm Hg, or DBP > 100 mm Hg)
Equipment Needed:
Clear hallway/walkway
Tape to mark measurements
Stopwatch
Norms: Vary by age, gender, and associated disease.
6 Minute Walk Test(1, 9) Purpose: Six minute walk test was first developed to test exercise tolerance in chronic respiratory disease and heart failure. The test is now used as a performance-based measure of functional exercise capacity in several populations as well. Method: Measures distance an individual is able to walk in 6 minutes on a hard, flat, indoor surface. Individual is able to self pace and rest as needed when walking back and forth along a roughly 30 meter marked walkway/hallway. Encouragement from administer is used, but exact protocol needs to documented. Population: Was developed for frail community dwelling elderly patients 60-90 years of age being referred to hospital. However, tests can be used in a variety of chronic disease adult and pediatric populations, as well as, healthy adults. Various conditions it is used on include, knee or hip OA, fibromyalgia, heart failure, COPD, and stroke. Considerations: Every participant will have differing functional statuses, therefore differing exertion levels. Such as, for patients with moderate to severe heart or lung disease, there are detailed instructions provided by the American Thoracic Society (ATS) which highlights how patients may become out of breath or exhausted (2). Best to walk in a hallway, instead of on treadmill, in order for the participant to self-adjust pace. Contraindications:
Unstable angina or MI in previous month
High blood pressure (resting HR > 120, SBP of 180 mm Hg, or DBP > 100 mm Hg)
Test should be stopped if participant reports chest pain, intolerable shortness of breath, leg cramps, staggering, diaphoresis, or pale/ashen appearance. Equipment Needed:
~30 meter flat walking area
Cones or tape to mark boundaries
Timer
Chair available for patient if rest is needed
Norms: Difficult to use normative values because varying studies use different methods. Norms vary by age, gender, and associated disease.
Healthy adults generally range from 400m – 700m
Improvement of ~50m has shown to be a clinically important difference
Proper Assessment Selection The 10 meter walk test is not generally used to assess cardiopulmonary dysfunction. It is used when assessment of gait speed and functional mobility is needed. (8) The 2-minute walk test is said to be just as reliable as the longer tests when assessing cardiopulmonary disorders. Best used when space is limited, and co-morbidities being a limiting factor in exercise tolerance. The duration of the 2 minute walk test is an adequate amount of time to assess gait speed and velocity. (8) The 6-minute walk test is the most commonly used outcome measure in the clinic. It is considered to be the most appropriate outcome measure to assess exercise response and endurance. (7, 8) Exercise tolerance has become an important outcome measure for patients with COPD. (7) There is also a 12-minute walk test that is administered the same as the 6-minute walk test. It is suggested that the longer test (12MWT) is best for assessing functional capabilities due to a stronger correlation between VO2max changes and 12-MWT changes. (7) The 2-, 6-, and 12-minute walk tests provide a structured framework for walking speed and endurance to be measured and progress to be followed over time. (8)
Function ATSCoPSfCP. ATS statement: guidelines for the six-minute walk test. American Jornal of Respiratory and Critical Care Medicine. 2002; 166(1): 111-7.
D.M. Connelly, B.K. Thomas, S.J. Cliffe, W.M. Perry, and R.E. Smith. Clinical Utility of the 2-Minute Walk Test for Older Adults Living in Long-Term Care. Physiother Can. 2009 Spring; 61(2): 78-87. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792234/
Mario Cazzola, Gian Luca Biscione, Franco Pasqua, Girolmina Crigna, Massimiliano Appodia, Vittorio Cardaci, Luigi Ferri. Use of 6-min and 12-min walking test for assessing efficacy of formoterol in COPD. Oct. 2008. Vol 102, Issue 10, Pages 1425-1430. http://www.resmedjournal.com/article/S0954-6111(08)00169-8/fulltext
Six-Minute Walk Test. American Thoracic Society (2002). Guidelines for the Six-Minute Walk Test. American Journal of Respiratory and Critical Care Medicine. 166:1, 111-117.
Objectives:
The objectives of this page are to:
Information:
10 Meter Walk Test(3, 4)
Purpose: Assesses gait speed over a distance of 10 meters. Can be employed to determine functional mobility, gait and vestibular function.
Method: Individual walks without assistance for 10 meters and the time is measured in the middle 6 meters to allow 2 meters for acceleration and 2 meters for deceleration. Start time when toes of leading foot cross the 2 meter mark and stop time when toes of leading foot cross 8 meter mark. Can be performed at preferred walking speed or fastest speed possible. Perform 3 trials and calculate the average of the 3 trials. Instruction form can be found at: http://assets.ngin.com/attachments/document/0052/8705/10_Meter_Walk_Test_Protocol.pdf
Population: Used to assess Alzheimer's disease, MS, Parkinson's disease, SCI, Stroke, TBI, Hip fracture, LE amputation, and Geriatrics.
Considerations: An assistive device can be used, but should remain consistent and documented from test to test. Can be done at normal gait speed or maximum gait speed, just needs to be documented.
Contraindications:
- If physical assistance is required to walk
Equipment Needed:- Stopwatch
- Clear pathway
- Tape to measure set distances
Norms: Vary for each disease and for gait speed performed. Norms vary by age and gender as well.2 Minute Walk Test (5,6)
Purpose: Two minute walk test can be used to measure physical endurance and function in an older patient population with various diagnosis.
Method: Measure distance participants walk without assistance in 2 minutes on a hard, flat, indoor surface. A hallway shorter than 100 feet may be used. Participants are instructed to walk at their fastest speed, but are allowed to self-adjust/slow down if needed. Encouragement from administer is used, but exact protocol needs to documented. Instruction form can be found at:
http://www.rehabmeasures.org/PDF%20Library/2%20Minute%20Walk%20Test%20Instructions.pdf
Population: Most commonly for patients with cardiopulmonary dysfunction. Patients with varying co-morbidities that precludes them from performing more intensive tests.
Considerations: An assistive device can be used, but should remain consistent and documented from test to test. This test is most commonly used when patients have co-morbidities that affect their physical or functional endurance, and they are unable to perform a test that lasts longer. Can also be used to assess gait speed and velocity. This test may also be used when space is problem, a hallway that is less than 100 feet long is adequate.
Contraindications:
- If physical assistance is required to walk
- Uncontrolled heart disease
- High blood pressure (resting HR > 120, SBP of 180 mm Hg, or DBP > 100 mm Hg)
Equipment Needed:- Clear hallway/walkway
- Tape to mark measurements
- Stopwatch
Norms: Vary by age, gender, and associated disease.6 Minute Walk Test (1, 9)
Purpose: Six minute walk test was first developed to test exercise tolerance in chronic respiratory disease and heart failure. The test is now used as a performance-based measure of functional exercise capacity in several populations as well.
Method: Measures distance an individual is able to walk in 6 minutes on a hard, flat, indoor surface. Individual is able to self pace and rest as needed when walking back and forth along a roughly 30 meter marked walkway/hallway. Encouragement from administer is used, but exact protocol needs to documented.
Population: Was developed for frail community dwelling elderly patients 60-90 years of age being referred to hospital. However, tests can be used in a variety of chronic disease adult and pediatric populations, as well as, healthy adults. Various conditions it is used on include, knee or hip OA, fibromyalgia, heart failure, COPD, and stroke.
Considerations: Every participant will have differing functional statuses, therefore differing exertion levels. Such as, for patients with moderate to severe heart or lung disease, there are detailed instructions provided by the American Thoracic Society (ATS) which highlights how patients may become out of breath or exhausted (2). Best to walk in a hallway, instead of on treadmill, in order for the participant to self-adjust pace.
Contraindications:
- Unstable angina or MI in previous month
- High blood pressure (resting HR > 120, SBP of 180 mm Hg, or DBP > 100 mm Hg)
Test should be stopped if participant reports chest pain, intolerable shortness of breath, leg cramps, staggering, diaphoresis, or pale/ashen appearance.Equipment Needed:
- ~30 meter flat walking area
- Cones or tape to mark boundaries
- Timer
- Chair available for patient if rest is needed
Norms: Difficult to use normative values because varying studies use different methods. Norms vary by age, gender, and associated disease.Proper Assessment Selection
The 10 meter walk test is not generally used to assess cardiopulmonary dysfunction. It is used when assessment of gait speed and functional mobility is needed. (8)
The 2-minute walk test is said to be just as reliable as the longer tests when assessing cardiopulmonary disorders. Best used when space is limited, and co-morbidities being a limiting factor in exercise tolerance. The duration of the 2 minute walk test is an adequate amount of time to assess gait speed and velocity. (8)
The 6-minute walk test is the most commonly used outcome measure in the clinic. It is considered to be the most appropriate outcome measure to assess exercise response and endurance. (7, 8)
Exercise tolerance has become an important outcome measure for patients with COPD. (7)
There is also a 12-minute walk test that is administered the same as the 6-minute walk test. It is suggested that the longer test (12MWT) is best for assessing functional capabilities due to a stronger correlation between VO2max changes and 12-MWT changes. (7)
The 2-, 6-, and 12-minute walk tests provide a structured framework for walking speed and endurance to be measured and progress to be followed over time. (8)
References:
1) American College of Rheumatology. October 2011. __https://www.rheumatology.org/Practice/Clinical/Clinicianresearchers/Outcomes_Instrumentation/Six_Minute_Walk_Test_(6MWT)/__